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Your Rights with a Medicare Supplement Plan


Medicare Consumer Rights

Your Rights as a Medicare Supplement Consumer Open Enrollment

Open enrollment for Medicare supplement plans is the one-time only, six-month period during which you may buy a Medicare supplement plan. Companies must sell you a policy - even if you have health problems - if you are at least 65 and apply within six months after enrolling in Medicare Part B. You must have both Medicare parts A and B to purchase a Medicare supplement plan.

You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and buy any other Medicare supplement policy.

Although a company must sell you a policy during your open-enrollment period, it may require a waiting period of up to six months before it starts covering your preexisting conditions.
Preexisting conditions are conditions for which you received treatment or medical advice from a physician within the previous six months.

You are entitled to an open enrollment period even if you wait for several years after you become 65 to enroll in Medicare Part B because of continued employment or other reasons.

Texans with Disabilities

People under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right only applies to Medicare supplement Plan A.

Companies that sell Medicare supplement plans in Texas may not deny you a Plan A policy because you have preexisting conditions. Companies may offer the other plans to Texans with disabilities, but they are not required.

Note: During the first six months after you turn 65 and are enrolled in Medicare Part B, you will have a right to buy any of the 10 plans.

Guaranteed Issue Right

You may have the right to buy a Medicare supplement policy outside of your open enrollment period if you lose certain types of health coverage. To be eligible for the guaranteed issue right, you must provide proof that you lost your health care coverage.

For people over age 65, the guaranteed issue right applies to Medicare supplement plans A, B, C, F, K, and L.

Texans under age 65 with disabilities who enroll in Medicare Part B also have guaranteed issue rights, but they are only eligible for Medicare supplement coverage under Plan A. This guaranteed issue right is also extended to people on Medicare who lose Medicaid because of a change in their financial situation.

In general, the guaranteed issue right is valid for 63 days from the date coverage ends or from the date of notice that coverage will end. Companies may not place any restrictions, such as pre-existing condition waiting periods or exclusions, on these policies.

For more information about the situations that allow a guaranteed right, read
Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
.

30-Day “Free Look”

You can return your Medicare supplement policy within 30 days and get your money back with no questions asked. Be sure to keep a record of the date you received the policy. Read the policy as soon as you get it. If you return the policy to the company, use certified mail with a return receipt to prove that it was returned within the 30-day time limit.

The 30-day "free look" period does not apply to Medicare Advantage. If you drop Medicare supplement to join a Medicare Advantage plan, you may not be able to get your Medicare supplement policy back.

Renewability

All Medigap policies are guaranteed renewable. A company cannot cancel your policy or refuse to renew it unless you made intentional false statements on your application or you failed to pay your premium.

However, the amount of the premium is not guaranteed. An insurance company may raise your premium as often as once a year on a class basis. In addition, if you have an attained-age policy, a company may raise your premium on your birthday.

Medicare Supplement Claims

Your doctors and hospitals must submit Medicare claims to the insurance company or fiscal intermediary for you. In most cases, Medicare sends the claim to the Medicare supplement plan company and the company pays the doctor or hospital. If you receive a bill, review your Medicare Summary Notice and what your company paid to determine if you owe anything.

Medicare supplement policies pay only for services that Medicare considers medically necessary. You have the right to appeal the decision to deny a claim. The appeals process and deadline to request an appeal are described in your summary notice.

Texas law requires insurance companies to pay claims promptly. If your Medicare supplement company refuses to pay a claim for a Medicare-approved charge or delays payment of your claims, you or your doctor or hospital may file a complaint with TDI.

Group Medicare Supplement Insurance

Your rights with a group Medicare supplement policy are essentially the same as with an individual policy. Because the group might make decisions that are out of your control, you have the following additional protections:

  • If the group changes insurance companies, the new company must offer coverage to everyone who was covered. The new Medicare supplement policy must cover pre-existing conditions that were covered by the old policy.
  • If you leave the group, the insurance company must offer to provide uninterrupted Medicare supplement coverage with an individual policy or continuation of your group insurance.
  • If the group cancels its coverage, the insurance company must offer you either an individual policy with the benefits you had with the canceled policy or offer you a different policy that meets Texas requirements.

Medicare Supplement Insurance Resources

 

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